Impact of COVID-19 social distancing measures on lung transplant recipients: decline in overall respiratory virus infections is associated with stabilisation of lung function

Abstract

BackgroundCOVID-19 social distancing measures led to a dramatic decline in non-COVID respiratory virus (RV) infections, providing a unique opportunity to study their impact on annual FEV1 decline, episodes of temporary drop in lung function (TDLF) suggestive of infection and chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTR).MethodsAll FEV1 values of LTR transplanted between 2009-April 2020 were included. Annual FEV1 change was estimated with separate estimates for pre- social distancing (2009/2020) and the year with social distancing measures (2020/2021). Patients were grouped by individual TDLF frequency (frequent/infrequent). RV circulation was derived from weekly hospital-wide RV infection rates. Effect modification by TDLF frequency and RV circulation was assessed. CLAD and TDLF rates were analyzed over time.Results479 LTR (12 775 FEV1 values) were included. Pre- social distancing annual change in FEV1 was −114 mL [95%CI; −133; −94], while during social distancing FEV1 did not decline: +5 mL [−38; 48] (difference pre- versus during social distancing: p<0.001). The frequent TDLF subgroup showed faster annual FEV1 decline compared to infrequent TDLF (−150 mL [−181; −120] versus −90 mL [−115; −65] p=0.003). During social distancing, we found significantly lower odds for any TDLF (OR 0.53 [0.33; 0.85], p=0.008) and severe TDLF (OR 0.34 [0.16; 0.71] p=0.005) as well as lower CLAD incidence (OR 0.53 [0.27; 1.02] p=0.060). Effect modification by RV circulation indicated a significant association between TDLF/CLAD and RVs.ConclusionDuring social distancing the strong reduction in RV circulation coincided with markedly less FEV1 decline, fewer TDLFs and possibly less CLAD. Effect modification by RV circulation suggests an important role for RVs in lung function decline in LTR.

Impact of SARS-CoV-2-Related Hygiene Measures on Community-Acquired Respiratory Virus Infections in Lung Transplant Recipients in Switzerland

“…Therefore, this could be interpreted as the main driving force behind the decline in CARV infections. This is supported by three other investigations on LTR cohorts during the COVID-19 pandemic with similar conclusions [ 4 , 31 , 32 ].…”

“…In the context of the COVID-19 pandemic, many other studies have investigated the effect of hygiene measures on CARV infections [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Only three further investigations have analyzed the impact of COVID-19-related measures on lung transplant recipients’ infection rates [ 4 , 31 , 32 ]. We think lung transplant recipients are an ideal cohort to investigate when considering the effects of government-imposed hygiene measures on CARV infections.…”

“…We think lung transplant recipients are an ideal cohort to investigate when considering the effects of government-imposed hygiene measures on CARV infections. First, CARV infections pose a big threat to lung transplant recipients, with possible lung function decline in the case of ALAD and a strong association with the development of CLAD [ 1 , 4 , 7 , 12 , 14 ]. Thus, preventing such infections is paramount for these patients.…”

“…Often leading to self-limiting upper respiratory tract infections, these viruses may cause serious complications and can harm the long-term outcome of LTRs. CARV infections frequently lead to an acute lung allograft dysfunction (ALAD), which is characterized by lung function decline, which, in some cases, may never recover [ 4 ]. Although many studies are inconclusive on the potential triggers of acute rejection episode, there is increasing evidence that such CARV infections are strongly associated with the development of chronic lung allograft dysfunction (CLAD) [ 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

“…CARV infections frequently lead to an acute lung allograft dysfunction (ALAD), which is characterized by lung function decline, which, in some cases, may never recover [ 4 ]. Although many studies are inconclusive on the potential triggers of acute rejection episode, there is increasing evidence that such CARV infections are strongly associated with the development of chronic lung allograft dysfunction (CLAD) [ 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. LTRs are also considered to be more vulnerable than other solid organ transplant recipients (SOT), most likely because the transplanted organ is in direct contact with the environment and is directly affected by these infections [ 15 ].…”